Acute Respiratory Failure and Metabolic Acidosis Due to Excessive Normal Saline Absorption During Hysteroscopic Myomectomy: A Case Report.

Hysteroscopic myomectomy commonly employs fluid irrigation to maintain visualization of the uterine cavity, with normal saline often used as the distension medium due to its favorable safety profile. However, significant intravascular absorption of isotonic fluids can result in life-threatening complications. We report a case of acute respiratory failure and severe hyperchloremic metabolic acidosis caused by excessive absorption of normal saline during hysteroscopic myomectomy. The patient required mechanical ventilation and intensive care but recovered fully with timely and appropriate management. This case underscores the need for vigilant fluid balance monitoring during hysteroscopic procedures, even when isotonic irrigation solutions are used.